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Monday, February 25, 2008

It happened yesterday in our department head meeting. The nice lady who represents our “WOW” council, “Works on Wellness”, was presenting yet again about the benefits of signing up, and encouraging/coercing our staffs to do so. It is “perfectly safe and confidential,” she said. Then she said, “Chris, as our Privacy Officer, what do you think?”

Well, I had already decided I was going to take the moral low ground and not opine publicly about my reservations. I had attended some of these presentations before, read Arthur Caplan’s great piece (which a colleague forwarded to me) about these programs (http://blog.bioethics.net/2007/08/art-caplan-on-msnbc-privacy-is-true-price-of-healt/) and had shared with my boss, the CFO, my concerns. This is a big initiative involving at least 15 hospitals, and I knew our CEO was heavily invested in our participation. I still have some interest in avoiding professional suicide. But now I was on the spot. I tried to hedge with, “you don’t really want to know”, making a joke, but she insisted.

For those of you who aren’t familiar, and many of you soon will be if you are not, this program, like many others nationally, has the stated goal of making employees more healthy. Employees are encouraged to go on line to a website, enter in their personal information, sign up for classes, even get a wellness coach. They enter in when their last physical was, and get points for doing all those screenings we should all be doing—cholesterol, mammograms, colonoscopies, etc. etc. They get points (and discounts) for exercise classes and joining Weight Watchers.Why? Aside from all the free/discounted education and the chance to track your health “quotient” in comparison to your peers, participants get a reduction in their insurance premiums for participating, and the more they participate, the more dollar credits they get. Not only that, but the organization gets an overall premium reduction too, based on the percentage of employees who participate. No wonder the top management sends regular emails encouraging staff to sign up, and now wants to enlist the department heads in doing the same type of 'encouraging'. Discounts for health insurance are a pretty powerful incentive.

“Perfectly safe and confidential”. Mmmm…. That is a tough one. Not a month goes by that there isn’t some famous security breach concerning PHI (Protected Health Information in HIPAA-speak) involving some pretty big organizations--- VA, Pentagon, Anthem—who you would expect to be current on technological ways to protect privacy. And, as Dr. Caplan points out, some organizations are already substituting a stick for the financial carrot—now you may have to pay more than your colleague if you are unlucky (or is it really your fault?) enough to have a high cholesterol level, still be addicted to nicotine, or, perhaps, carry a gene that will predispose you to expensive cancer treatment at some point in the future.

You might argue, and some in the room did, that it is only fair that those of us who don’t work to be healthy pay more than our exercising non red meat eating colleagues. What about those who don’t wear helmets or seat belts? Surely we shouldn’t have to pay for your care when you get into that wreck that could have been avoided. And of course our organization, even though a non profit, needs to stay afloat and provide care for our patients. Why not “tax” our employees to our benefit. The whole concept is, in a way, a bit like “sin taxes”--- taxes on alcohol and cigarettes and those other things we know we shouldn’t be doing. And what about if we elect to have children knowing that they may have an inherited disorder? Well, who wants to pay for that?

So, I looked around the room at my colleagues, some of whom are friends, and put in my two cents, quoting the Caplan article. As a result, I have been trading emails with the WOW coordinator all morning to defend/explainmy position. So far, I haven’t gotten into any real trouble with my bosses.

HIPAA has been cursed and touted for all kinds of things. Even though it was not the intent of the federal law, which originally had to do with moving insurance from one employer to another, Privacy and Security became two of the three pillars of the statute, which at least requires “covered entities”to notify patients about what is happening to their PHI (Notice of Privacy Practices). Yet, even I, who do this for a living, toss these flyers in the trash when I get them, and quickly “agree” to explanations about the security of the websites I visit without reading the fine print. The law hasn’t really helped much, since there are so many loopholes that allow the courts and others to get information without the permission of patients.

A friend of mine’s mother was recently diagnosed with breast cancer, and all of the daughters sought genetic counseling. The doctor performing the testing and counseling advised my friend not to go through her insurance to get it paid for, warning her that the repercussions could be anything from refusal to provide life insurance to some future employer just deciding that another candidate, without the potential illness ahead, is better qualified. Studies show that 1 out of 4 docs deliberately exclude sensitive information from patient records at their request, and I would guess that number to be higher in truth.

For now, I am going to forgo the extra dollars in my paycheck and take care of my health because it is right for me and my family, not because my employer wants me to. And, I am going to advise anyone who asks me to do the same.

2 comments:

I was reading a woman's personal blog the other day, and she was overweight and dreading her employer's upcoming wellness campaign. Dreading to the point of looking for another job. In addition to the very valid privacy concerns, I suspect a lot of people really hate these campaigns and I wonder if they're all that effective at bringing about behavior change.

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